Citation Nr: 18150811 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-60 724 DATE: November 15, 2018 REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a skin condition is remanded. Entitlement to service connection for left sided sciatica is remanded. Entitlement to service connection for right sided sciatica is remanded. REASONS FOR REMAND The Veteran served on active duty from December 2008 through May 2012. 1. Entitlement to service connection for a lumbar spine disability is remanded. The Veteran’s service treatment records reflect that she reported back pain with weight bearing in January 2009. She reported that she was informed during her induction physical that she had curvature of the spine, but no x-rays were taken. Physical examination reflected her thoracic spine had normal appearance, no abnormalities, and no muscle spasm. Later in January 2009, the Veteran sought followup for her back pain. Physical examination reflected that her thoracic spine did not show normal curvature, and she was diagnosed with scoliosis. X-rays of the Veteran’s spine taken at the end of January 2009 reflected she did not have thoracic or lumbar curvature meeting the criteria for scoliosis. She did have mild pelvic tilt with her right hip four millimeters higher than her left hip. However, scoliosis appears on the Veteran’s chronic problems list throughout her active duty service. Accordingly, it is unclear from the record whether the Veteran had preexisting scoliosis. The Board notes that the Veteran’s service treatment records do not contain a copy of her entrance physical referenced in the January 2009 treatment record. Memorandums dated January and February 2013 indicate that a thorough and complete search of all records associated with the Veteran had been conducted, and her service treatment records were considered complete. However, a disclosure and accounting record reflects that the Veteran requested her medical records be mailed to her home in June 2012. On remand, the Regional Office (RO) should request the Veteran send any service treatment records she may have in her possession. The Veteran’s post-service VA treatment records also appear incomplete. An April 2015 VA treatment record reflects the Veteran had questions about the x-rays taken of her back. The Veteran’s private chiropractic records dated April through May 2015 also note x-rays were taken of her lumbar spine. However, the record does not contain evidence of any x-rays taken in April 2015. In support of her claim, the Veteran submitted a nexus statement provided by her private chiropractor. The chiropractor noted the Veteran had reported back pain caused by her injuries during her time in the military and opined that the Veteran’s injuries could have been caused by her rigorous military duties. This opinion has limited probative evidentiary value. First, it is based on the subjective reports provided by the Veteran and not an objective review of her claims file, to include her service treatment records. Second, the nexus statement noted her current lumbar spine symptomatology “could have been caused” by her military service. As the private nexus statement is expressed in the terms “could have” it is too speculative to establish a causal relationship, and the opinion is of little probative value. See Bloom v. West, 12 Vet. App. 185, 186-87 (1999). The Board similarly does not find the September 2015 VA examination to be of probative evidentiary value. The examiner noted the Veteran only reported back pain twice in service and had no evidence of a chronic condition; however, her service treatment records indicate she reported back pain through the entire month of January 2009 and she was diagnosed with scoliosis, which appeared consistently on her chronic problems list. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a lumbar spine disability because the current opinions are insufficient to decide the claim. 2. Entitlement to service connection for a left knee disability is remanded. 3. Entitlement to service connection for a right knee disability is remanded. The Veteran seeks entitlement to service connection for left and right knee disabilities. Service treatment records reflect the Veteran was seen for chronic knee pain in February 2009. In March 2009, she reported taking pain medication to treat her knee pain. Post-service treatment records reflect the Veteran complained of bilateral knee pain in January 2015. She was referred to physical therapy and an x-ray to evaluate her bilateral knees was ordered. The Board does not find the September 2015 VA examinations to be of probative evidentiary value. The examiner opined that the Veteran did not have a currently diagnosed right knee disability, and thus no nexus to service could be identified. As for the Veteran’s left knee disability, the examiner opined that there was no evidence in the claims file that the Veteran reported any left knee injuries or complaints either during or after service. However, that opinion appears to be based on a factual inaccuracy, and the Veteran should be afforded a new exam to determine the etiology of her knee disabilities. Additionally, the Veteran’s VA treatment records reflect she was referred to physical therapy and an x-ray was ordered for her knees. The claims file contains neither the x-ray, nor any physical therapy records, and they should be obtained on remand. 4. Entitlement to service connection for a skin condition is remanded. The Veteran seeks entitlement to service connection for a skin condition. Specifically, she claims she noticed patches on her chest area and shoulders, which had worsened. See September 2015 VA examination. Service treatment records reflect she reported skin discoloration on her chest in September 2011 and was diagnosed with pityriasis rosea. She was also noted to have had a skin rash in January and February 2012. The Veteran was afforded a VA examination in September 2015. The examiner noted that the Veteran did not currently have and had never had a skin condition. However, the examiner also noted that the Veteran used cream and medicated shampoo for a skin fungus. The examiner opined that the Veteran did not have a currently diagnosed skin condition, and thus no nexus to service could be provided. Post-service VA treatment records reflect the Veteran first sought treatment through VA in October 2012 and reported having a rash on her right forearm. She also reported experiencing a rash on her chest since her deployment in 2011. In July 2014 she was evaluated for a skin condition. She reported having a persistent papular nodular skin rash. Physical examination revealed a half-inch round area on her upper chest and a small raised area under her left eyelid. In October 2014 she reported having a rash on her chest since she was deployed and was diagnosed with probable tinea versicolor. Accordingly, the September 2015 VA examination of the Veteran’s skin condition appears to be based on a factual inaccuracy, and the Veteran should be afforded a new exam to determine the etiology of her currently diagnosed skin condition.   5. Entitlement to service connection for left sided sciatica is remanded. 6. Entitlement to service connection for right sided sciatica is remanded. The Veteran seeks entitlement to service connection for bilateral sciatica. Specifically, she asserts that her sciatica is related to her lumbar spine disability. The determination of the claim for entitlement to service connection for a lumbar spine disability may affect the outcome of the claims for entitlement to service connection for left and right sided sciatica. Accordingly, the issues are intertwined. The matters are REMANDED for the following action: 1. Obtain the following VA treatment records: (a.) The x-ray taken of the Veteran’s spine in approximately April 2015; (b.) Records of any x-rays and physical therapy for the Veteran’s bilateral knees; and (c.) VA treatment records for the period from October 2015 to the present. 2. Sent the Veteran a letter requesting that she submit any service medical records she may have in her possession. 3. ONLY AFTER the above development has been completed, to the extent possible, schedule the Veteran for an examination to determine the nature and etiology of any lumbar spine disability. The examiner is requested to provide the following opinions: (a.) If the Veteran’s entrance physical is obtained and it notes evidence of scoliosis at entry, whether the Veteran’s preexisting scoliosis was at least as likely as not aggravated (non-temporary increase in severity) by service and, if so, whether any increase in severity was clearly and unmistakably (undebatable) due to its natural progress. (b.) If the Veteran’s entrance physical is not obtained, whether any diagnosed scoliosis clearly and unmistakably (undebatable) preexisted the Veteran’s service. If the examiner finds it did clearly and unmistakably preexist service, the examiner must opine whether it was clearly and unmistakably not aggravated by service. If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including her complaints of pain with weightbearing. (c.) If the examiner determines that the Veteran’s in-service diagnosis of scoliosis was incorrect (specifically referencing the January 2009 physical exam indicating an abnormal thoracic curvature and January 2009 x-ray showing no evidence of scoliosis), whether the Veteran’s currently diagnosed lumbar spine disability is etiologically related to her active duty service, to include her complaints of back pain with weightbearing. (d.) ONLY IF it is determined that the Veteran’s lumbar spine disability is etiologically related to her active duty service, provide an opinion as to whether the Veteran has any neurological conditions (i.e., sciatica) related to her lumbar spine disability. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any bilateral knee disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including her February 2009 diagnosis of chronic knee pain. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any skin condition. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including her September 2009 diagnosis of pityriasis rosea. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parsons, Associate Counsel